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Sanjay V Patel - One of the best experts on this subject based on the ideXlab platform.

  • Long-term keratometric changes after penetrating keratoplasty for keratoconus and Fuchs Endothelial Dystrophy.
    Transactions of the American Ophthalmological Society, 2020
    Co-Authors: Matthew E. Raecker, Jay C. Erie, Sanjay V Patel, William M. Bourne
    Abstract:

    PURPOSE: To compare long-term keratometric changes after penetrating keratoplasty (PK) for keratoconus and Fuchs Endothelial Dystrophy. METHODS: We retrospectively analyzed 168 corneas after PK for keratoconus (85 eyes of 63 subjects) and Fuchs Dystrophy (83 eyes of 60 subjects). Patients were examined after final suture removal at 12 months after PK to 30 years after surgery. Operations were performed by one surgeon using the same suturing technique in all cases. Eyes were excluded from further analysis after regrafting or after relaxing incisions. Mean keratometric corneal power and astigmatism were measured by manual keratometry. Data were assessed by using generalized estimating equation models to determine change over time. RESULTS: Mean keratometric corneal power and keratometric astigmatism increased through 30 years after PK for keratoconus (P < .001 and P < .001) but did not change through 20 years after PK for Fuchs Dystrophy (P = .55 and P = .55). The change in keratometric corneal power and astigmatism after PK in keratoconus patients differed from the change in Fuchs Dystrophy patients only at 10 or more years after PK (P = .002 and P = .003). CONCLUSIONS: Corneal curvature and regular astigmatism increase progressively after PK for keratoconus but remain stable after PK for Fuchs Dystrophy. This keratometric instability after PK for keratoconus may lead to delayed corneal ectasia.

  • Optical and Anatomic Changes in Fuchs Endothelial Dystrophy Corneas
    Current Treatment Options for Fuchs Endothelial Dystrophy, 2016
    Co-Authors: Katrin Wacker, Jay W Mclaren, Sanjay V Patel
    Abstract:

    The advent of Endothelial keratoplasty and improvements in corneal imaging have advanced our understanding of the optical and anatomic properties of corneas with Fuchs Endothelial Dystrophy before and after keratoplasty. Corneal changes appear earlier in the course of Fuchs Endothelial Dystrophy than previously considered, indicating disease chronicity, probably in response to a state of long-term subclinical corneal edema. These early changes increase optical aberrations and light scatter that decrease visual acuity and increase disability glare, respectively. Because many of the structural changes that contribute to aberrations and scatter originate in the anterior cornea, they persist in the host cornea after Endothelial keratoplasty and even after corneal edema has resolved. These factors that originate early in the disease process probably determine the visual outcomes of Endothelial keratoplasty for Fuchs Endothelial Dystrophy.

  • vision related quality of life before and after keratoplasty for fuchs Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]). Design Prospective, observational case series. Participants Sixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups ( P  = 0.88). Vision-related quality of life improved by 6 months (PK, P  = 0.008; DLEK, P  = 0.03; DSEK, P P  = 0.01) and DSEK ( P  = 0.004). At 6 months, the composite score was higher after DSEK than after PK ( P  = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments ( P  = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year ( r  = −0.38; P  = 0.001) and at 3 years ( r  = −0.36; P  = 0.02), with disability glare at 3 years ( r  = −0.41; P  = 0.02), and with best-corrected visual acuity at 6 months ( r  = −0.34; P  = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes.

  • objective assessment of the corneal endothelium in fuchs Endothelial Dystrophy
    Investigative Ophthalmology & Visual Science, 2014
    Co-Authors: Jay W Mclaren, Lori A Bachman, Katrina M Kane, Sanjay V Patel
    Abstract:

    PURPOSE: To develop a standardized method of Endothelial cell density (ECD) assessment in Fuchs' Endothelial Dystrophy that maximizes the sample area and uses the clearest Endothelial cells in confocal images. METHODS: The corneal endothelium of 51 eyes from 30 patients, with varying degrees of Fuchs' Endothelial Dystrophy, was examined using confocal microscopy. In two or three distinct images of the central endothelium, local contiguous cell density was determined using a variable frame method. The effective ECD was the product of the local cell density and the fraction of the image that was free of guttae. Two examiners assessed the severity of disease in each eye during slit-lamp examination and assigned a severity grade of 1 to 6. In a second group of 55 eyes with Fuchs' Dystrophy from 30 patients, the clinical grade was predicted from the effective ECD and the regression coefficients of the first group and compared to the subjective clinical grade assigned by one examiner. RESULTS: The effective ECD decreased linearly with subjective grade (r = -0.93, P < 0.001). The grade predicted from the effective ECD differed from the subjective clinical grade by -0.1 ± 0.8 (mean difference ± standard deviation). CONCLUSIONS: The effective ECD in confocal images provides an objective means of assessing the corneal endothelium in Fuchs' Dystrophy and might be a useful tool in clinical studies.

  • Vision-related quality of life before and after keratoplasty for fuchs' Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    ParticipantsSixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Design Prospective, observational case series. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = -0.38; P = 0.001) and at 3 years (r = -0.36; P = 0.02), with disability glare at 3 years (r = -0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = -0.34; P = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes. Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]).

Eleanor R. Trousdale - One of the best experts on this subject based on the ideXlab platform.

  • vision related quality of life before and after keratoplasty for fuchs Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]). Design Prospective, observational case series. Participants Sixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups ( P  = 0.88). Vision-related quality of life improved by 6 months (PK, P  = 0.008; DLEK, P  = 0.03; DSEK, P P  = 0.01) and DSEK ( P  = 0.004). At 6 months, the composite score was higher after DSEK than after PK ( P  = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments ( P  = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year ( r  = −0.38; P  = 0.001) and at 3 years ( r  = −0.36; P  = 0.02), with disability glare at 3 years ( r  = −0.41; P  = 0.02), and with best-corrected visual acuity at 6 months ( r  = −0.34; P  = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes.

  • Vision-related quality of life before and after keratoplasty for fuchs' Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    ParticipantsSixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Design Prospective, observational case series. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = -0.38; P = 0.001) and at 3 years (r = -0.36; P = 0.02), with disability glare at 3 years (r = -0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = -0.34; P = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes. Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]).

Leo J. Maguire - One of the best experts on this subject based on the ideXlab platform.

  • vision related quality of life before and after keratoplasty for fuchs Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]). Design Prospective, observational case series. Participants Sixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups ( P  = 0.88). Vision-related quality of life improved by 6 months (PK, P  = 0.008; DLEK, P  = 0.03; DSEK, P P  = 0.01) and DSEK ( P  = 0.004). At 6 months, the composite score was higher after DSEK than after PK ( P  = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments ( P  = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year ( r  = −0.38; P  = 0.001) and at 3 years ( r  = −0.36; P  = 0.02), with disability glare at 3 years ( r  = −0.41; P  = 0.02), and with best-corrected visual acuity at 6 months ( r  = −0.34; P  = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes.

  • Vision-related quality of life before and after keratoplasty for fuchs' Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    ParticipantsSixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Design Prospective, observational case series. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = -0.38; P = 0.001) and at 3 years (r = -0.36; P = 0.02), with disability glare at 3 years (r = -0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = -0.34; P = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes. Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]).

  • host and graft thickness after descemet stripping Endothelial keratoplasty for fuchs Endothelial Dystrophy
    American Journal of Ophthalmology, 2010
    Co-Authors: Kamran Ahmed, Jay W Mclaren, Leo J. Maguire, Keith H Baratz, K M Kittleson, Sanjay V Patel
    Abstract:

    Purpose To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping Endothelial keratoplasty (DSEK). Design Prospective, cohort study. Methods Forty-four eyes with Fuchs Endothelial Dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. Results Total corneal thickness was 610 ± 50 μm (mean ± standard deviation) before DSEK, increased to 680 ± 74 μm by 1 month after DSEK ( P P = .03 vs 1 month). Graft thickness was 170 ± 57 μm at 1 month, decreased to 157 ± 49 μm by 3 months ( P = .004), and then remained stable through 12 months (156 ± 51 μm; P = .99 vs 3 months). BCVA was 0.44 ± 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 ± 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months ( P P Conclusions Stromal edema resolves by 3 months after DSEK for Fuchs Dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter.

Keith H Baratz - One of the best experts on this subject based on the ideXlab platform.

  • vision related quality of life before and after keratoplasty for fuchs Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]). Design Prospective, observational case series. Participants Sixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups ( P  = 0.88). Vision-related quality of life improved by 6 months (PK, P  = 0.008; DLEK, P  = 0.03; DSEK, P P  = 0.01) and DSEK ( P  = 0.004). At 6 months, the composite score was higher after DSEK than after PK ( P  = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments ( P  = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year ( r  = −0.38; P  = 0.001) and at 3 years ( r  = −0.36; P  = 0.02), with disability glare at 3 years ( r  = −0.41; P  = 0.02), and with best-corrected visual acuity at 6 months ( r  = −0.34; P  = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes.

  • Vision-related quality of life before and after keratoplasty for fuchs' Endothelial Dystrophy
    Ophthalmology, 2014
    Co-Authors: Eleanor R. Trousdale, William M. Bourne, Leo J. Maguire, Keith H Baratz, David O Hodge, Sanjay V Patel
    Abstract:

    ParticipantsSixty-three subjects with Fuchs' Endothelial Dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Design Prospective, observational case series. Methods Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Main Outcome Measures Vision-related quality of life composite score. Results Vision-related quality of life composite score for all eyes with Fuchs' Dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = -0.38; P = 0.001) and at 3 years (r = -0.36; P = 0.02), with disability glare at 3 years (r = -0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = -0.34; P = 0.03), but not thereafter. Conclusions Vision-related quality of life in patients with Fuchs' Endothelial Dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of Endothelial keratoplasty over PK with respect to patient-reported outcomes. Purpose To assess vision-related quality of life in Fuchs' Dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar Endothelial keratoplasty [DLEK], and Descemet stripping Endothelial keratoplasty [DSEK]).

  • host and graft thickness after descemet stripping Endothelial keratoplasty for fuchs Endothelial Dystrophy
    American Journal of Ophthalmology, 2010
    Co-Authors: Kamran Ahmed, Jay W Mclaren, Leo J. Maguire, Keith H Baratz, K M Kittleson, Sanjay V Patel
    Abstract:

    Purpose To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping Endothelial keratoplasty (DSEK). Design Prospective, cohort study. Methods Forty-four eyes with Fuchs Endothelial Dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. Results Total corneal thickness was 610 ± 50 μm (mean ± standard deviation) before DSEK, increased to 680 ± 74 μm by 1 month after DSEK ( P P = .03 vs 1 month). Graft thickness was 170 ± 57 μm at 1 month, decreased to 157 ± 49 μm by 3 months ( P = .004), and then remained stable through 12 months (156 ± 51 μm; P = .99 vs 3 months). BCVA was 0.44 ± 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 ± 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months ( P P Conclusions Stromal edema resolves by 3 months after DSEK for Fuchs Dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter.

Jay W Mclaren - One of the best experts on this subject based on the ideXlab platform.

  • Optical and Anatomic Changes in Fuchs Endothelial Dystrophy Corneas
    Current Treatment Options for Fuchs Endothelial Dystrophy, 2016
    Co-Authors: Katrin Wacker, Jay W Mclaren, Sanjay V Patel
    Abstract:

    The advent of Endothelial keratoplasty and improvements in corneal imaging have advanced our understanding of the optical and anatomic properties of corneas with Fuchs Endothelial Dystrophy before and after keratoplasty. Corneal changes appear earlier in the course of Fuchs Endothelial Dystrophy than previously considered, indicating disease chronicity, probably in response to a state of long-term subclinical corneal edema. These early changes increase optical aberrations and light scatter that decrease visual acuity and increase disability glare, respectively. Because many of the structural changes that contribute to aberrations and scatter originate in the anterior cornea, they persist in the host cornea after Endothelial keratoplasty and even after corneal edema has resolved. These factors that originate early in the disease process probably determine the visual outcomes of Endothelial keratoplasty for Fuchs Endothelial Dystrophy.

  • objective assessment of the corneal endothelium in fuchs Endothelial Dystrophy
    Investigative Ophthalmology & Visual Science, 2014
    Co-Authors: Jay W Mclaren, Lori A Bachman, Katrina M Kane, Sanjay V Patel
    Abstract:

    PURPOSE: To develop a standardized method of Endothelial cell density (ECD) assessment in Fuchs' Endothelial Dystrophy that maximizes the sample area and uses the clearest Endothelial cells in confocal images. METHODS: The corneal endothelium of 51 eyes from 30 patients, with varying degrees of Fuchs' Endothelial Dystrophy, was examined using confocal microscopy. In two or three distinct images of the central endothelium, local contiguous cell density was determined using a variable frame method. The effective ECD was the product of the local cell density and the fraction of the image that was free of guttae. Two examiners assessed the severity of disease in each eye during slit-lamp examination and assigned a severity grade of 1 to 6. In a second group of 55 eyes with Fuchs' Dystrophy from 30 patients, the clinical grade was predicted from the effective ECD and the regression coefficients of the first group and compared to the subjective clinical grade assigned by one examiner. RESULTS: The effective ECD decreased linearly with subjective grade (r = -0.93, P < 0.001). The grade predicted from the effective ECD differed from the subjective clinical grade by -0.1 ± 0.8 (mean difference ± standard deviation). CONCLUSIONS: The effective ECD in confocal images provides an objective means of assessing the corneal endothelium in Fuchs' Dystrophy and might be a useful tool in clinical studies.

  • in vivo confocal microscopy of fuchs Endothelial Dystrophy before and after Endothelial keratoplasty
    JAMA Ophthalmology, 2013
    Co-Authors: Sanjay V Patel, Jay W Mclaren
    Abstract:

    Importance This study reveals significant changes of the anterior cornea in Fuchs Endothelial Dystrophy that probably affect the visual outcomes of Endothelial keratoplasty for the disease. Objective To determine whether abnormalities of corneal stromal and subepithelial cells in Fuchs Endothelial Dystrophy resolve after Descemet stripping Endothelial keratoplasty (DSEK). Design Prospective observational study of 49 corneas of 42 patients with Fuchs Dystrophy before DSEK and during 3 years of postoperative follow-up. None of the preoperative corneas were vascularized or had pronounced subepithelial fibrosis on results of slitlamp examination. Corneas were examined using in vivo confocal microscopy to determine stromal cell density and the presence of abnormal subepithelial cells (presumed fibroblasts). Setting The cornea service at Mayo Clinic, Rochester, Minnesota. Participants Forty-nine corneas of 42 patients. Intervention Descemet stripping Endothelial keratoplasty. Main Outcome Measures Stromal cell density and presence of subepithelial cells. Results Subnormal cell density in the most anterior 10% of the host stroma in Fuchs Dystrophy before DSEK (mean [SD], 22 030 [6479] cells/mm 3 [n = 41]) remained unchanged at 2 (20 433 [4993] cells/mm 3 [n = 35]; P = .36) and 3 years (20 925 [5433] cells/mm 3 [n = 23]; P = .99) after DSEK. Abnormal subepithelial cells, which formed reticular networks deep to the basal epithelial cells, were visible in 33 eyes (67%) and remained present at 3 years after DSEK. Mean preoperative central corneal thicknesses when these subepithelial cells were and were not visible were 652 (45) and 668 (56) μm, respectively (P = .75). Conclusions and Relevance The reduced cellularity of the anterior stroma in Fuchs Dystrophy does not recover 3 years after restoring Endothelial function. Abnormal subepithelial cells, presumably fibroblasts, are present in most corneas with Fuchs Dystrophy requiring DSEK, even in cases with mild edema and in the absence of clinically obvious preoperative subepithelial fibrosis. Anterior corneal structural abnormalities might be related to visual outcomes after DSEK.

  • host and graft thickness after descemet stripping Endothelial keratoplasty for fuchs Endothelial Dystrophy
    American Journal of Ophthalmology, 2010
    Co-Authors: Kamran Ahmed, Jay W Mclaren, Leo J. Maguire, Keith H Baratz, K M Kittleson, Sanjay V Patel
    Abstract:

    Purpose To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping Endothelial keratoplasty (DSEK). Design Prospective, cohort study. Methods Forty-four eyes with Fuchs Endothelial Dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. Results Total corneal thickness was 610 ± 50 μm (mean ± standard deviation) before DSEK, increased to 680 ± 74 μm by 1 month after DSEK ( P P = .03 vs 1 month). Graft thickness was 170 ± 57 μm at 1 month, decreased to 157 ± 49 μm by 3 months ( P = .004), and then remained stable through 12 months (156 ± 51 μm; P = .99 vs 3 months). BCVA was 0.44 ± 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 ± 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months ( P P Conclusions Stromal edema resolves by 3 months after DSEK for Fuchs Dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter.

  • Long-term keratometric changes after penetrating keratoplasty for keratoconus and Fuchs Endothelial Dystrophy.
    American Journal of Ophthalmology, 2008
    Co-Authors: Matthew E. Raecker, Jay W Mclaren, Jay C. Erie, David O Hodge, Sanjay V Patel, William M. Bourne
    Abstract:

    Purpose To compare long-term keratometric changes after penetrating keratoplasty (PK) for keratoconus and Fuchs Endothelial Dystrophy. Design Retrospective, comparative case series. Methods We retrospectively analyzed 168 corneas after PK for keratoconus (85 eyes of 63 subjects) and Fuchs Dystrophy (83 eyes of 60 subjects). Patients were examined after final suture removal at 12 months after PK to 30 years after surgery. Operations were performed by one surgeon (W.M.B.) using the same suturing technique in all cases. Eyes were excluded from further analysis after regrafting or after relaxing incisions. Mean keratometric corneal power and astigmatism were measured by manual keratometry. Data were assessed by using generalized estimating equation models to determine change over time. Results Mean keratometric corneal power and astigmatism increased through 30 years after PK for keratoconus ( P P P = .55 and P = .55) The change in keratometric corneal power and astigmatism after PK in keratoconus patients only differed from the change in Fuchs Dystrophy patients 10 or more years after PK ( P = .002 and P = .003). Conclusions Corneal curvature and regular astigmatism increase progressively after PK for keratoconus, but remain stable after PK for Fuchs Dystrophy. Our data suggest that keratometric instability after PK for keratoconus is attributable to delayed, progressive ectasia in the host corneal rim.